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    THankyou for updating us and posting all the information about the walking therapy. I spent today discussing it with my PT colleague and showing it to my OT colleague. Surprising how rudimentary it is-pulpit rollator and elastic bands. just goes to show that sometimes back to basics is the best policy. If this form of therapy works it kinda puts the lokomat and FES walking machine in its place!
    Really wish i could spend more time with my daughter doing this as would be so easy to replicate with her size but she is busy being an eight year old and having therapy is like having to go to bed! Currently using RGO's in parallel bars.
    Looking forward to hearing the outcome and hearing about upcoming trials in children. Noirin has T1 injury ASia A but has significant damage -from T4 with signal disruption to C6. Is returning to shriners again in few weeks.

    Comment


      Originally posted by noirin's mum View Post
      THankyou for updating us and posting all the information about the walking therapy. I spent today discussing it with my PT colleague and showing it to my OT colleague. Surprising how rudimentary it is-pulpit rollator and elastic bands. just goes to show that sometimes back to basics is the best policy. If this form of therapy works it kinda puts the lokomat and FES walking machine in its place!
      Really wish i could spend more time with my daughter doing this as would be so easy to replicate with her size but she is busy being an eight year old and having therapy is like having to go to bed! Currently using RGO's in parallel bars.
      Looking forward to hearing the outcome and hearing about upcoming trials in children. Noirin has T1 injury ASia A but has significant damage -from T4 with signal disruption to C6. Is returning to shriners again in few weeks.
      Noirun's Mum,

      It is hard to imagine any other method that allows people to walk 6 hours a day, 6 days a week. Any weight support harness would cause sores and be quite dangerous to the skin. When I first saw this approach, it seemed to be quite simplistic but it is more complicated an it seems. First, the transition from standing to stepping is complicated and involves quite a lot of upper arm work. Second, the figure 8 bnd around the ankle is really a möbius strip. Third, many people were wearing high top tennis shoes. Fourth, they tape the rear wheels of the rolling device so that it can be used to provide some friction for the person to use to push the device forward. Fifth, many people develop callouses on their elbows where they rest their weight.

      Wise.

      Comment


        Originally posted by Wise Young View Post
        Noirun's Mum,

        It is hard to imagine any other method that allows people to walk 6 hours a day, 6 days a week. Any weight support harness would cause sores and be quite dangerous to the skin. When I first saw this approach, it seemed to be quite simplistic but it is more complicated an it seems. First, the transition from standing to stepping is complicated and involves quite a lot of upper arm work. Second, the figure 8 bnd around the ankle is really a möbius strip. Third, many people were wearing high top tennis shoes. Fourth, they tape the rear wheels of the rolling device so that it can be used to provide some friction for the person to use to push the device forward. Fifth, many people develop callouses on their elbows where they rest their weight.

        Wise.
        Sounds like the risk outweighs the benefit
        Donnie: Dr. Xiao, What are your thoughts on a cure/combination therapy for SCI's??
        CG Xiao: Donnie, I don't want to disappoint you, but I think it is impossible to restore the continuity of the cord or "bridge the gap" in the near future, let's say: 50 years. Dr Wise Young has been my most respected scientist in SCI. He has dedicated and contributed to SCI no other can match.

        Comment


          Originally posted by Donnie View Post
          Sounds like the risk outweighs the benefit


          Shut up Donny you're out of your element!!

          Comment


            Thanks for all the info you are providing to us Dr.Young. If possible, I want to know how are responding the bodies to a hard exercise routine after years in chairs. Tendons, muscles, bones (are you monitoring bone density or muscle mass changes?),... and if the patients have special diet with supplements to help them.
            -Ramps in buildings are necessary, but it would be usefull to have another ones for people (mind/heart).....

            -Hoc non pereo habebo fortior me

            Comment


              Isildur - thats a good question.
              Im worried about how my joints will be affected if a cure does happen. Until then I take fish oil pills and a very good multi vitamin with added joint support (orange triad).
              c6 inc since 2-19-11
              ex pro-am motocross racer
              tilite aero z s2

              Comment


                Originally posted by Donnie View Post
                Sounds like the risk outweighs the benefit
                Donnie, I was responding to Noirun's Mom, who was raising an interesting question about the method of walking at Kunming versus the other weight-support methods that they use in the United States. By the way, I apologize for all the typographical errors. That is what happens when I am using my iPad and typing the answers in a car.

                In Kunming, they use this rolling cart, no bracing, no weight support harness, and only two elastic ankle bands to prevent foot drop. They believe that use of weight support harnesses is not good and that braces impede locomotor recovery. They eschew weight-bearing harnesses because most harnesses focus pressure on relatively small patches of skin, often around the pelvis and between the legs. The risk of developing pressures sores is high if a person walks in a weight-supporting harness for 6 hours a day.

                In the U.S. and Europe, they like to use braces, weight-supporting harnesses, and robotics. While there have been significant improvements in weight-support harnesses (I described one of them in a post recently) and walking on a treadmill saves the backs of physical therapists who must crouch to direct the foot placement, I would still be reluctant to recommend that any person do even 3 hours a day in such a harness, much less 6 hours a day. So, in my opinion, I think that all the weight-supporting harness systems are no good for intensive training.

                The risks of the walking program at Kunming seem to be low. While I have seen many hundreds of patients at Kunming undergo this training during the months after injury, this was the first time that I have seen this procedure being applied to chronic patients. Yes, they develop callouses on their feet and forearms/elbow. We had a scare last February when two patients complained of pain in their legs and x-rays showed presence of what seem to be fractures. However, upon review of earlier x-rays, the fractures seem to have been there before. In any case, none of the 20 subjects with chronic spinal cord injury have suffered any major fractures even though all of them have the typical osteoporosis that all chronic spinal cord injured patients have. They seem to be able to tolerate the intensive walking program for at least 3 months and some are continuing to 6 months.

                Wise.
                Last edited by Wise Young; 13 Jun 2012, 6:48 AM.

                Comment


                  Wise, I am not sure you have seen the following consideration and quetion I have posted before:

                  Around minute 43 of your talk you show a Diffusion Tensor Image of the first patient that was transplanted in HK and then you say that in many patients you are "seeing axons growing accross the gap"
                  I would suggest that if you claim that you should also show a DTI image that support what you are saying, otherwise you are asking people to have blind faith in your words.
                  Me and many other CC members are very anxious to see these DTIs and I hope all goes well getting the data published with the DTIs included.

                  Then I have a question:

                  to my knoledge DTI can't show axons, but just a "mathematical riconstruction" of the image of the spinal cord were myelin is present i.e. tissue with white matter,
                  Is that correct?

                  Paolo

                  P.S. to all the CC members: I have donated money and I have convinced friends to donate money to support Wise's work, so I believe I have the right to ask questions.
                  In God we trust; all others bring data. - Edwards Deming

                  Comment


                    Originally posted by paolocipolla View Post
                    P.S. to all the CC members: I have donated money and I have convinced friends to donate money to support Wise's work, so I believe I have the right to ask questions.
                    Why do you donate, why don't you fix tings yourselfe. You seams capable doing tings on youre own.

                    Comment


                      As for detecting axons by DTI/MR ask Simens or GE.

                      Comment


                        Originally posted by Wise Young View Post
                        ...this was the first time that I have seen this procedure being applied to chronic patients. Yes, they develop callouses on their feet and forearms/elbow. We had a scare last February when two patients complained of pain in their legs and x-rays showed presence of what seem to be fractures. However, upon review of earlier x-rays, the fractures seem to have been there before. In any case, none of the 20 subjects with chronic spinal cord injury have suffered any major fractures even though all of them have the typical osteoporosis that all chronic spinal cord injured patients have...
                        How do the muscles respond? I've been told and read that it's fibrous tissue that would not respond? Have there been before/after tests to see how the muscles are reacting?
                        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

                        Comment


                          callouses? oh no! i better just keep my butt in this chair and get pressure sores instead.

                          Comment


                            Everybody,

                            People can ask questions and don't have to donate money to ask questions. What people don't have the right to do here on CareCure is to question somebody's honesty, integrity, motivation, intelligence, or work ethics when asking questions. That just leads to anger, erodes friendships, and causes miscommunication.

                            Wise.
                            ----------------------

                            Paolo,

                            Please be patient. I have been writing an answer to your question and it is taking more time than I had thought. I should have posted that I will be answering part of your question. By the way, please do not expect me to present detailed data about our study and you simply will have to wait until we have it accepted for publication before I present such data.

                            Wise.

                            Magnetic resonance diffusion tensor imaging (MR-DTI)

                            Magnetic resonance diffusion tensor imaging (MR-DTI) is a method of analyzing magnetic resonance data so that it shows water diffusion. As you know, standard magnetic resonance detects water (H2O). Water is the most abundant molecule in biological tissues and excitation of H2O by pulses of electromagnetic energy in a strong magnetic field will perturb the molecule so that it emits energy back in a specific frequency. Movement of water produces changes of magnetic resonance in sequential snapshots of the tissue. Normally, in non-oriented tissues, water diffuses in all directions. However, in oriented tissues, the diffusion will be more restricted in some directions than others. This property is called anisotrophy.

                            White matter is the most oriented tissues in the central nervous system, containing bundles of fibers running longitudinally for long distances. Also called diffusion MRI (dMRI), MR-DTI has been used for mapping diffusion in brain tissues since the early 1980's. During the last 25 years, it has been applied to many neurological conditions and has served as the basis of the Human Brain Connectome project, which is building maps of anatomical and functional connections of the human brain. Many studies have now been published on MR-DTI of spinal white matter. For example, a search "diffusion tensor imaging" and "spinal cord" on Google Scholar yielded over 150 published articles on the subject.

                            Software is now available for a user to select an area of interest (i.e. white matter above the injury site or below the injury site) and the program will find contiguous tissues that show the same directional diffusion characteristics. In other words, the software will show bundles of oriented fibers that are contiguous with each other. By doing so, we can see the white matter above the injury site and below the injury site. If any white matter tracts were to regrow across the injury site, we should be able to see them cross the injury site. So, we used MR-DTI in our trial to identify the injection sites (at the white matter wave fronts rostral and caudal to the injury site) and to detect white matter growth across in the injury site. The degree and volume anisotrophy can be quantified to assess white matter change.

                            Mulcahey, et al. [1] at Shriner’s hospital recently examined the DTI images of children with spinal cord injury. They found good-to-strong reliability on repeated scans and moderate-to-good concurrent validity with clinical (ASIA) classifications of the injury. They concluded that DTI is a better predictor of clinical findings (i.e. AIS A, B, C, D, E) than conventional MRI. Freund, et al. [2] imaged nine adult volunteers with cervical spinal cord injury and found significant differences of corticospinal tract of SCI subjects compared to controls, including ability to predict paralysis of different parts of the body. Bosma & Stroman [3] reviewed studies using DTI to visualize spinal cords in patients with amyotrophic lateral sclerosis, myelitis, and spinal cord tumors. Smith, et al. [4] at Kennedy Krieger in Baltimore reported that DTI images can reliably discriminate sensory and motor tracts. Ellington, et al. [5] compared four subjects with spinal cord injury with 4 normal subjects. They found a general decrease in both longitudinal and transverse diffusivity in the former.

                            Many investigators have used DTI to investigate animal models of spinal cord injury. Tu, et al. [6] at Washington University in St. Louis used DTI to quantify spared white matter in mice after contusion injuries. Sundberg, et al. [7] used DTI to assess rats at various times up to 56 days after contusion injuries. White matter in regions up to a centimeter from the injury site showed significant changes that were not seen on conventional MRI. Histological evidence confirmed significant decrease in myelin and oligodendrocyte presence in these areas of the spinal cord, suggesting that DTI images are sensitive reflection of not only the volume but also the quality of white matter. Kim, et al. [8, 9] at Washington University showed that DTI can predict long-term locomotor recovery in mice after graded contusion injuries. Herrara, et al. [10] pointed out that while DTI can detect demyelination, axonal damage and longitudinal diffusivity (lambda) did not always correlate. Ellingson, et al. [11] found that both transverse and longitudinal diffusivity (tADC and lADC), as well as mean diffusivity (MD) and fractional anisotrophy (FA), changed over time in rodents after injury.

                            Nobody has looked at human spinal cords before and after cell transplants, or changes in white matter associated with transplants. Therefore, we planned such a study in Hong Kong. It was a very difficult study because the presence of metallic implants around the injury site distorted the images and introduced artifacts. Most patients have such metallic implants. Also, we had to work out many issues, including the parameters that would be used for imaging the white matter. We hypothesized that subjects with “complete” ASIA A spinal cord injuries would not have any white matter crossing the injury site, that injections of small amounts of cells (i.e. 4 and 8 µliters) would not change the white matter in the spinal cord, and that restoration of function would be associated with appearance of white matter bundles crossing the injury site. So, we did a study of MR-DTI images of 8 subjects with chronic SCI before and at 6 weeks, 6 months, 12 months (and 18 months) after transplantation umbilical cord blood mononuclear cells (four injections of 4 or 8 µliters) in the spinal cord above and below and injury site. These are compared with 8 normal control subjects.

                            This will be the subject of the study that we will soon submit for publication.

                            References Cited

                            1. Mulcahey MJ, Samdani A, Gaughan J, Barakat N, Faro S, Betz RR, et al. Diffusion tensor imaging in pediatric spinal cord injury: preliminary examination of reliability and clinical correlation. Spine (Phila Pa 1976). 2012;37(13):E797-803.
                            2. Freund P, Wheeler-Kingshott CA, Nagy Z, Gorgoraptis N, Weiskopf N, Friston K, et al. Axonal integrity predicts cortical reorganisation following cervical injury. J Neurol Neurosurg Psychiatry. 2012;83(6):629-37. PMCID: 3348614.
                            3. Bosma R, Stroman PW. Diffusion tensor imaging in the human spinal cord: development, limitations, and clinical applications. Crit Rev Biomed Eng. 2012;40(1):1-20.
                            4. Smith SA, Jones CK, Gifford A, Belegu V, Chodkowski B, Farrell JA, et al. Reproducibility of tract-specific magnetization transfer and diffusion tensor imaging in the cervical spinal cord at 3 tesla. NMR Biomed. 2010;23(2):207-17. PMCID: 2830283.
                            5. Ellingson BM, Ulmer JL, Schmit BD. Morphology and morphometry of human chronic spinal cord injury using diffusion tensor imaging and fuzzy logic. Ann Biomed Eng. 2008;36(2):224-36.
                            6. Tu TW, Kim JH, Wang J, Song SK. Full tensor diffusion imaging is not required to assess the white-matter integrity in mouse contusion spinal cord injury. J Neurotrauma. 2010;27(1):253-62. PMCID: 2824236.
                            7. Sundberg LM, Herrera JJ, Narayana PA. In vivo longitudinal MRI and behavioral studies in experimental spinal cord injury. J Neurotrauma. 2010;27(10):1753-67. PMCID: 2992395.
                            8. Kim JH, Loy DN, Wang Q, Budde MD, Schmidt RE, Trinkaus K, et al. Diffusion tensor imaging at 3 hours after traumatic spinal cord injury predicts long-term locomotor recovery. J Neurotrauma. 2010;27(3):587-98. PMCID: 2867549.
                            9. Kim JH, Tu TW, Bayly PV, Song SK. Impact speed does not determine severity of spinal cord injury in mice with fixed impact displacement. J Neurotrauma. 2009;26(8):1395-404. PMCID: 2850293.
                            10. Herrera JJ, Chacko T, Narayana PA. Histological correlation of diffusion tensor imaging metrics in experimental spinal cord injury. J Neurosci Res. 2008;86(2):443-7.
                            11. Ellingson BM, Kurpad SN, Schmit BD. Ex vivo diffusion tensor imaging and quantitative tractography of the rat spinal cord during long-term recovery from moderate spinal contusion. J Magn Reson Imaging. 2008;28(5):1068-79.



                            Originally posted by paolocipolla View Post
                            Wise, I am not sure you have seen the following consideration and quetion I have posted before:

                            Around minute 43 of your talk you show a Diffusion Tensor Image of the first patient that was transplanted in HK and then you say that in many patients you are "seeing axons growing accross the gap"
                            I would suggest that if you claim that you should also show a DTI image that support what you are saying, otherwise you are asking people to have blind faith in your words.
                            Me and many other CC members are very anxious to see these DTIs and I hope all goes well getting the data published with the DTIs included.

                            Then I have a question:

                            to my knoledge DTI can't show axons, but just a "mathematical riconstruction" of the image of the spinal cord were myelin is present i.e. tissue with white matter,
                            Is that correct?

                            Paolo

                            P.S. to all the CC members: I have donated money and I have convinced friends to donate money to support Wise's work, so I believe I have the right to ask questions.
                            Last edited by Wise Young; 14 Jun 2012, 10:54 AM.

                            Comment


                              Originally posted by lynnifer View Post
                              How do the muscles respond? I've been told and read that it's fibrous tissue that would not respond? Have there been before/after tests to see how the muscles are reacting?
                              Lynnifer,

                              I have seen many people go through the walking program in Kunming. Their muscles seem to be okay. Most people with cervical and thoracic spinal cord injury are spastic and it seems to help them with their standing.

                              Do you have a lumbosacral injury and have atrophy in your legs? Severely atrophied muscles may become fibrotic, i.e. muscle fibers are replaced by fibrous (scar) tissues. If you can stretch your muscles, they are not fibrotic.

                              Even if they are, there will be ways to get around the problem. We may have to inject myoblasts into the muscles to rebuild them when we re-innervate them. This will have to be done for lumbosacral injuries.

                              Walking is also not the be-all and end-all of spinal cord regeneration. Long tract regeneration, if it is indeed occurring, should improve bowel, bladder, and other function as well.

                              We had to choose primary outcome measures in the first trials. I expect that there will other trials that will be looking for bladder and bowel, and even sexual function, if the treatment is regenerating the spinal cord.

                              I am hoping that our next generation of trials will focus on lumbosacral spinal cord injury. As I have explained, we will probably need to do neuronal replacement as well as regeneration.

                              Wise.
                              Last edited by Wise Young; 14 Jun 2012, 10:14 AM.

                              Comment


                                What Dr. Young actually said at the June Open House was:

                                "We also now have Diffusion Tensior Imaging of these patients, and the Hong Kong study suggests that many of the axons are actually growing across the injury site."

                                He never said that the DTIs actually showed the axons. You can say he meant it, but he didn't say it.

                                What really bugs me is that people ask for hints at how the trials are going and then jump on gaps in the hints. Furthermore, I hate to see Dr. Young wasting his time defending his unpublished work. Maybe he should do what Dr. Davies did, just say "Wait until it's published."

                                Sorry, I'll resume lurking.
                                Last edited by khmorgan; 14 Jun 2012, 11:30 AM.

                                Comment

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